The use of beta-blockers is not associated with increased daytime sleepiness in patients with obstructive sleep apnoea

Abstract

Background: Increased daytime sleepiness is a known side-effect of beta-blockers. These medications are indicated in cardiovascular disease and hypertension which frequently accompany obstructive sleep apnoea (OSA). Physicians may be reluctant to prescribe beta-blockers in cardiovascular patients with co-morbid OSA, not to worsen excessive daytime sleepiness. However, the association between beta-blockers and daytime sleepiness in OSA has not been investigated before. Methods: We analysed the results of 286 patients who were admitted to our Sleep Laboratory due to suspected OSA. We excluded subjects who used any sedative drugs, including anti-depressants, melatonin or benzodiazepines. None of them had been treated with CPAP or mandibular advancement device. Participants filled out the Epworth Sleepiness Scale (ESS) and underwent an in-hospital polysomnography. Results: 197 patients were diagnosed with OSA (apnoea-hypopnoea index, AHI≥5/h). 73 subjects used beta-blockers, including 62 patients with OSA (25 bisoprolol, 21 nebivolol, 7 metoprolol, 6 carvedilol, 2 betaxolol, 1 propranolol). ESS directly related to AHI in OSA (p=0.04, r=0.14) and total sleep time in non-OSA controls (p=0.03, r=0.31). There was no relationship between the ESS and the use of beta-blockers in OSA (p=0.22) or in controls (p=0.43). However, interestingly, bisoprolol was significantly associated with lower ESS in OSA (n=25, r=-0.15, p=0.02). Conclusions: Beta-blockers in general are not associated with excessive daytime sleepiness in OSA. However, lipophilic agents penetrating through the blood-brain barrier (i.e. propranolol or metoprolol) should be investigated separately.